Community mental health services--the New Zealand experience

This overview focuses on a provision of current mental health services in New Zealand and might help professionals from other countries to become familiar with its community based model of care. New Zealand mental health services have undergone significant changes over the last 40 years. These include the closure of old psychiatric hospitals and the development of community based treatment facilities. The New Zealand government has been closely involved with the organisation of mental health services providing strategic directions and financial support. So far much has been accomplished, however some gaps still remain.     

Mental health nursing and cultural diversity

The focus of this article is on ethnic cultural difference. The establishment of a bi-cultural model of health care delivery has been a recent priority in New Zealand. Bi-culturalism has become an important concept for Maori and Pakeha (Europeans), working in partnership in the planning and implementation of mental health services in New Zealand. Adoption of the principles of respect and recognition of the uniqueness of different cultural identities, by nurses, has meant that clients who use mental health services in New Zealand are beginning to benefit from nursing care that is culturally competent.     

医疗人员对居住在新西兰克赖斯特彻奇的中国人的精神卫生服务状况的观点

背景：移民会给人带来压力，也有可能会提高在海外居住的中国人的精神疾病患病率。文化习俗和服务的缺乏也许会阻碍他们寻求所需的精神卫生服务。 目的：评估新西兰的医疗人员关于来自中国大陆的移民对精神卫生服务的使用状况的观点。 方法：本定性研究在新西兰克赖斯特彻奇完成。研究者深入访谈了9名有服务中国客户经验的精神卫生专业人员，并把访谈内容进行笔录以及主题分析。 结果：访谈内容中出现了四个主题：（1）中国移民的特殊心理问题；（2）移民中最容易出现心理问题的人群；（3）妨碍获得服务的因素；（4）社会支持网络对中国移民的心理健康的重要性。 结论：通过对高收入国家中为日益增长的中国大陆移民提供心理健康服务的医疗人员的定性研究，可以找出需要提高对文化的敏感度的地方，以此来增加中国移民对精神卫生服务的利用，提高服务的效率。     

Mental Health Tribunal Processes and Advocacy Arrangements: “Little Wins” are No Small Feat*

This article examines the meaning of advocacy and the absence of advocacy in the context of mental health tribunal processes, and focuses on the adequacy and availability of legal representation. The article reflects on observational and interview data, and considers tribunal processes within the broader context of decision-making about treatment, care, and service delivery. Although effective advocacy can be a powerful tool to achieve positive outcomes for the subjects of tribunal proceedings, existing advocacy arrangements often leave this potential unfulfilled. Barriers include: an unduly narrow focus on the legal issues to be determined by mental health tribunals; a failure to accept the intimate link between such legal issues and the broader health and life needs of mental health service clients; and funding and resource limitations. It is argued that a well-structured, -connected, and -resourced system of advocacy services, combining ongoing independent advocacy with regularized and effective legal representation, should be given serious consideration.     

Private and public psychiatry: a comparison of two health care systems

Psychiatrists in Australia and New Zealand are similarly trained, but the health care delivery systems in each country differ. Australia has unlimited insurance for fee-for-service private practice and has twice the psychiatrists and half the psychiatric beds per capita as New Zealand. Psychiatrists in the public sector in each country focus on hospital-based care of psychotic patients. Private-sector psychiatrists, in addition to caring for psychotic patients, also focus on psychotherapy for neuroses and personality disorders. The Australian combination of more psychiatrists in private office practice and fewer public hospital beds costs less than the New Zealand system, which supports only public-sector, hospital-based services.     

An advocacy model for people with long-term psychiatric disabilities

Traditional rights protection and advocacy systems in the mental health field have focused primarily on the use of legal processes to protect patients in inpatient settings. This paper describes a study of an advocacy model designed to help frequent users of mental health services adjust more successfully to community living. Clients who were offered advocacy services related to self-identified problems and needs were compared with a control group who were not offered the services. During the study period clients who received the advocacy services were hospitalized significantly fewer days than the control group with no increase in psychiatric symptoms, but the differences between the two groups disappeared after advocacy services were terminated. The authors compare the advocacy intervention to case management and discuss the potential role of advocacy services in mental health systems.     

Needs and Gaps Analysis: Problem Gambling Interventions Among New Zealand Asian Peoples

Asian peoples are the fastest growing population in New Zealand. This study was conducted to increase the understanding of Asian problem gambling and identify gaps in intervention services. 52 people from 4 major cities in New Zealand participated. Data were collected either through telephone interview, filling in the written survey or face-to-face interaction. The results indicate that Asian peoples in New Zealand who gamble are gambling at casinos and that the most vulnerable groups are international students, restaurant owners and workers, and tourist operators. The impacts of problem gambling on Asian peoples include declines in work productivity or study performance, decreased quality of health, emotional and financial stress on families both in New Zealand and overseas. The report concludes with a discussion of the needs and gaps that the current health system of New Zealand faces and makes a series of recommendations in the area of public health interventions and counseling services that can be used for policy makers in order to meet the complex and multiple needs of Asian peoples.     

Chile mental health country profile

This paper describes main facts about Chile starting with key socio-demographic, socio-economic, political, environmental, epidemiological, social support and social pathology aspects that characterize the context in which current mental and neurological policy and programmes have been put in place since 2000, as part of the National Health Plan and Health Sector Strategy Plan. The ‘National Plan for Mental Health and Psychiatry’, using a community psychiatry approach, has been partially implemented for people covered by the Public Health Insurance, which comprises 62% of the Chilean population (people with lower income). This paper also describes: the management, population needs and demands, financial resources, human resources in primary care, mental health specialist care and community-based care, physical capital, social capital, provision and processes, and outcomes of the plan. Strengths are analyzed, like the health reform, including its values and principles, the active participation of consumer and family groups as well as mental health NGOs, access to mental health services through primary care, quality assurance of the mental health services delivered to the population and progressive development of a culture of respect for human rights, including those of people with mental illnesses. Finally, difficulties for the advance of mental health care are also enumerated: the low priority still given to mental health compared with physical health by the country's leaders, the insufficient emphasis on mental health in both undergraduate and postgraduate professional training, the strong stigma and discrimination associated with mental illness in the general population and the advocacy by some mental health professionals of the traditional model of care (role of the psychiatric hospital).     

Psychiatrists' recommendations for improving bicultural training and Maori mental health services: a New Zealand survey

OBJECTIVE: In the context of Maori being over-represented as clients, and underrepresented as professionals in New Zealand's mental health system, this study ascertained the beliefs of New Zealand's psychiatrists about issues pertaining to Maori mental health. The overriding objective was to gather recommendations as to how to improve bicultural training and mental health services for Maori. METHOD: A questionnaire involving closed and open-ended questions was sent to 335 New Zealand psychiatrists. RESULTS: Of the 247 psychiatrists (74%) responding, 40% believed their training had prepared them to work effectively with Maori. Recommendations for improving training focused on the need for greater understanding of Maori perspectives of well-being. Recommendations for improving mental health services for Maori highlighted the need for more Maori professionals and for Maori-run services. No psychiatrists thought that pakeha clinicians should not work with Maori clients, but the majority (70%) recognised the need to consult with Maori staff when doing so. Twenty-eight psychiatrists (11.3%), all male, New Zealand born, and with 10 or more years clinical experience, believed that Maori were biologically or genetically more predisposed than others to mental illness. Several respondents offered other racist comments. CONCLUSIONS: The high response rate and the many positive recommendations suggest a high level of constructive interest in these issues among psychiatrists. Comparisons with a simultaneous survey of psychologists are made. It is hoped that the recommendations might inform those responsible for training programs and for providing or purchasing mental health services.     

The care of individuals with mental retardation: lessons from the New Zealand experience

The care of individuals with mental retardation has changed with broad and growing acceptance of their place within the community. Data from a national study in New Zealand illustrates the influence of global trends in care, and the continuing need for advocacy in addition to clinical care. Effects of changing patterns of care on families and on agencies have been mixed as a result of the mismatch among political philosophies, demographic and social trends, and community changes. Support for families that care and for self advocacy are essential parts of the care system. Effective care depends on good communication and personal knowledge between the provider of care and the person with mental retardation. Sexual health and women's health issues are areas where good communication between the physician and patient are particularly important.Areas of continuing health care need are screening for hearing and visual problems, gastrointestinal disorders, dementia and depression, and review of medications. Involvement in fitness programs, recreational and social activities, and paid work are also identified as enhancing health. Support for self advocates and their families, and where necessary advocacy directed at improving the social environments and the standards of care available to individuals with mental retardation, are an integral part of the work of physicians caring for this population.     

Service costs of caring for adolescents with mental illness in a rural community, 1993-2000

OBJECTIVE: Costs of treating child psychiatric disorders fall on educational, primary care, juvenile justice, and social service agencies as well as on psychiatric services. The authors estimated multiagency mental health costs by integrating service unit costs with utilization rates in an 11-county area. Using psychiatric diagnoses made independently of service use records, the authors calculated costs across agencies as well as the extent of unmet need for psychiatric care. METHOD: Annual parent and child reports were used to measure mental health care needs and units of service across 21 types of settings for the population-based Great Smoky Mountain Study sample of 1,420 adolescents from ages 13 to 16. Unit costs for services were generated from information from service providers and records. The authors calculated costs overall, costs by type of service, and costs by diagnosis. RESULTS: Average annual costs per adolescent treated were $3,146. Juvenile justice and inpatient/residential facilities accounted for well over half of the total costs. Costs for youths with two or more diagnoses were twice as much as costs of those with a single disorder. Among adolescents with service needs, 66.9% received no services. Public health insurance was associated with higher rates of specialty mental health care than either private insurance or no insurance. CONCLUSIONS: Annual costs across all services were three to four times greater than recent health insurance estimates alone. Many costs for adolescents with mental health problems were borne by agencies not designed primarily to provide psychiatric or psychological services. Only one in three adolescents needing psychiatric care received any mental health services.     

Community forensic psychiatry: restoring some sanity to forensic psychiatric rehabilitation

OBJECTIVE: To review clinical and legal paradigms of community forensic mental health care, with specific focus on New Zealand, and to develop a clinically based set of guiding principles for service development in this area. METHOD: The general principles of rehabilitating mentally disordered offenders, and assertive community care programmes were reviewed and applied to the law and policy in a New Zealand forensic mental health setting. RESULTS: There is a need to develop comprehensive community treatment programmes for mentally disordered offenders. The limited available research supports assertive community treatment models, with specialist forensic input. Ten clinically based principles of care provision important to forensic mental health assertive community treatment were developed. CONCLUSION: Deinstitutionalization in forensic psychiatry lags behind the rest of psychiatry, but can only occur with well-supported systems in place to assess and manage risk in the community setting. The development of community-based forensic rehabilitation services in conjunction with general mental health is indicated.     

Chile mental health country profile

This paper describes main facts about Chile starting with key socio-demographic, socio-economic, political, environmental, epidemiological, social support and social pathology aspects that characterize the context in which current mental and neurological policy and programmes have been put in place since 2000, as part of the National Health Plan and Health Sector Strategy Plan. The 'National Plan for Mental Health and Psychiatry', using a community psychiatry approach, has been partially implemented for people covered by the Public Health Insurance, which comprises 62% of the Chilean population (people with lower income). This paper also describes: the management, population needs and demands, financial resources, human resources in primary care, mental health specialist care and community-based care, physical capital, social capital, provision and processes, and outcomes of the plan. Strengths are analyzed, like the health reform, including its values and principles, the active participation of consumer and family groups as well as mental health NGOs, access to mental health services through primary care, quality assurance of the mental health services delivered to the population and progressive development of a culture of respect for human rights, including those of people with mental illnesses. Finally, difficulties for the advance of mental health care are also enumerated: the low priority still given to mental health compared with physical health by the country's leaders, the insufficient emphasis on mental health in both undergraduate and postgraduate professional training, the strong stigma and discrimination associated with mental illness in the general population and the advocacy by some mental health professionals of the traditional model of care (role of the psychiatric hospital).     

Epidemiological studies on mental health needs of Asian population in New Zealand

BACKGROUND: New Zealand has recently experienced a massive and rapid influx of Asian migrants. The Asian population has doubled in 10 years and is now the third-largest ethnic group. MATERIALS: Databases reviewed include Medline, NZ government reports and NZ media releases. DISCUSSION: Despite the significant growth in the Asian population, most of whom are in a vulnerable age group for mental morbidity and are exposed to adverse experiences, accurate and systematically obtained information on the mental health of Asians is lacking. CONCLUSION: This paper argues for a need to conduct a well-designed epidemiological study on the mental health needs of Asians in New Zealand. Recommendations on how to pursue this epidemiological study are provided.     

Scoping the Australian mental health nursing workforce

This is the second of four articles on the Scoping Study of the Australian mental health nursing workforce conducted on behalf of the Australian and New Zealand College of Mental Health Nurses (ANZCMHN) for the Australian Health Ministers Advisory Council (AHMAC) National Working Group on Mental Health (NWGMH). Its purpose is to focus on overlooked issues in planning the mental health nursing workforce. Whereas it is acknowledged that there are problems in the supply of mental health nurses, it is argued that equal attention needs to be given to addressing the working conditions and rewards of mental health nurses.     

Perspectives on effective advocacy for homeless mentally ill persons.

To make appropriate treatment and public policy recommendations to address the problems of homeless mentally ill persons, it is important to differentiate the homeless mentally ill population from the homeless population in general. Effective advocacy for homeless mentally ill persons should have realistic goals that address the specific needs of that population rather than attempt to change the basic problems of society. The effective advocacy that has secured services for developmentally disabled persons can serve as a model. Mental health professionals' limited response to the problems of homeless mentally ill persons has further stigmatized mentally ill persons in general; one of the most powerful actions mental health professionals could take to fight stigma would be to help provide treatment and residential alternatives for homeless mentally ill persons. The recommendations of both the first and the second American Psychiatric Association task forces on the homeless mentally ill are discussed.     

Are psychiatrists equipped for management roles in mental health services?

OBJECTIVES: To promote the discussion of leadership and management skills development among psychiatrists in Australia and New Zealand. METHOD: A key informant survey of fellows of the Royal Australian and New Zealand College of Psychiatrists was conducted via a semi-structured interview. This canvassed views about leadership and management issues including levels of confidence and needs for additional skills. RESULTS: There was widespread support for psychiatrists to be in management roles in mental health services; however, on entering management positions, psychiatrists often felt inadequately trained and prepared for their new role. Furthermore, many who had made the transition to management perceived a lack of support from their clinical colleagues. Clinicians appeared to believe that management was not difficult to learn and could be done by any experienced clinician. The provision of short courses and mentoring programmes is the preferred option for most psychiatrists seeking to acquire leadership and management skills. CONCLUSIONS: For psychiatrists to maximize their potential as leaders in Australian and New Zealand mental health services, greater attention to promoting the acquisition of relevant skills throughout training and in the post-fellowship years is required. Psychiatrists need to be supported and encouraged to pursue further education, training and research in this area. Failure to address this issue risks psychiatrists continuing to feel disadvantaged in management roles and hence reluctant to undertake the challenge.     

Recovery in New Zealand: an evolving concept?

Recovery was first officially promoted in New Zealand in 1998 and it became a key concept in mental health service development. Since the mid 2000s however, recovery has been on the wane in New Zealand, but the fundamental concepts within the term live on in two more recently adopted terms: whanau ora and well-being. He Korowai Oranga (Maori Health Strategy) defines whanau ora as families being supported to achieve health and well-being. The extended family is recognized as a source of strength, identity, security and support. Whanau ora is underpinned by Te Whare Tapa Wha, a well-being model that focuses on health being a balance between Taha Wairua (spiritual health), Taha Tinana (physical health), Taha Hinengaro (psychological health) and Taha Whānau (family health). New Zealanders are also using the term well-being, not just for the whole population but for people diagnosed with mental illness. The advantages of placing recovery into the larger well-being agenda are reduced discrimination and segregation of people with a diagnosis into a distinct population group, reduced association with medical and deficits approaches that can counter the recovery approach, and bypassing the dilution of the recovery approach that has occurred in traditional services.